Lefrère B, Barbaud A, Bagot M, Bourgogne E
Assistance Publique des Hôpitaux de Paris, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France.
UTCBS, CNRS-Inserm, université de Paris, Paris, France.
Rev Fr Allergol (2009). 2021 Oct;61(6):425-431. doi: 10.1016/j.reval.2021.04.002. Epub 2021 May 12.
During the SARS-CoV-2 pandemic, the media has often mentioned the presence of quinine in tonic water. Media accounts of quinine's antiviral effect as well as press reports about quinine-based compounds, such as hydroxychloroquine, have sparked renewed public interest in drinking tonic water, which could perhaps result in an increase in allergic phenomena. On the 200th anniversary of the discovery of quinine, our main objective was to analyze hypersensitivity reactions, related to the consumption of beverages containing quinine, described in the literature.
We analyzed case reports indexed on Pubmed, Scopus, and Google Scholar. A quinine causality score was calculated for each of the observations. A quinine assay was performed on several beverages for which the quinine content had not been published.
In parallel with related pharmacokinetic studies, these case reports consist of 26 observations. The case reports mainly related to young men, with symptoms of varying severity, mainly dermatological, with fixed drug eruption, generalized rashes, hives; hematological, with thrombocytopenia, hemorrhagic syndrome, thrombotic microangiopathy; more rarely ocular, cardiac or auditory. The level of causality of quinine is certain for three cases, probable for twenty-two, possible for two. The levels of quinine, all conforming to the standards, were lower in the spirits and the cooked wine than those of tonic water.
Possibly under-diagnosed, the main mechanism of these reactions is immuno-allergic, without any cross-reaction with other quinolines having been shown. In these patients and breastfeeding women of G6PD deficient newborns, any medicines, phytotherapy, homeopathy, or even cosmetics containing quinine, on the basis of a proposed list, should be avoided.
在新型冠状病毒肺炎大流行期间，媒体经常提及奎宁在汤力水中的存在。媒体对奎宁抗病毒作用的报道以及关于基于奎宁的化合物（如羟氯喹）的新闻报道引发了公众对饮用汤力水的新兴趣，这可能导致过敏现象增加。在奎宁发现200周年之际，我们的主要目的是分析文献中描述的与饮用含奎宁饮料相关的过敏反应。
我们分析了在PubMed、Scopus和谷歌学术上索引的病例报告。为每个观察结果计算了奎宁因果关系评分。对几种奎宁含量未公布的饮料进行了奎宁检测。
与相关的药代动力学研究并行，这些病例报告包括26项观察结果。病例报告主要涉及年轻男性，症状严重程度各异，主要为皮肤病学症状，有固定性药疹、全身性皮疹、荨麻疹；血液学症状，有血小板减少、出血综合征、血栓性微血管病；眼部、心脏或听觉症状较少见。奎宁的因果关系水平在3例中为肯定，22例中为很可能，2例中为可能。烈酒和熟酒中的奎宁含量均符合标准，且低于汤力水中的含量。
这些反应的主要机制可能是免疫过敏，可能诊断不足，且未显示与其他喹啉有任何交叉反应。对于这些患者以及G6PD缺乏新生儿的哺乳期妇女，应根据建议清单避免使用任何含有奎宁的药物、植物疗法、顺势疗法甚至化妆品。
